No benefit from HRT for older women

New evidence confirms that hormone replacement therapy (HRT) should not be prescribed to older women who are many years past the menopause. The treatment will not help prevent chronic conditions such as heart disease in these women.

The findings of the WISDOM study, which was conducted by the Medical Research Council's General Practice Research Framework and Clinical Trials Unit in collaboration with clinicians in Australia and New Zealand are published on bmj.com.

A similar study, the Women's Health Initiative (WHI) study found in 2002 that postmenopausal women taking HRT had more heart attacks, strokes and breast cancers than non-HRT users, although they had fewer hip fractures and bowel cancers. The trial was halted early and millions of women around the world stopped taking HRT for disease prevention.

The latest findings are from the WISDOM study which began in 1999 to assess the long-term risks and benefits of HRT after the menopause. This study was stopped after the first WHI results appeared, and therefore the numbers of events were small.

Professor Janet Darbyshire, Director of the MRC Clinical Trials Unit said "There were more cases of angina, heart attack, sudden coronary death and blood clots in women taking the combined hormone therapy compared to women not taking HRT. The rates of stroke, breast and other cancers, fractures and overall deaths were not significantly different in these two groups."

"The WISDOM study confirmed these increased risks for older women starting hormone replacement therapy many years after the menopause," Professor Darbyshire added.

"Importantly, the WISDOM study showed that there is no overall disease prevention benefit from HRT and some potential risk for women who start hormone replacement therapy many years after menopause. However, most women take HRT for relief of menopausal symptoms, and quality of life is an important part of the equation. The findings relating to quality of life will be published when fully analysed"," said Dr Madge Vickers, former head of the MRC General Practice Research Framework, who led the study.

These results cannot necessarily be applied to younger women starting hormone replacement therapy at the time of the menopause to relieve symptoms such as hot flushes and night sweats. For these women, recent studies suggest there may be no additional risk, and possibly even cardiovascular benefits of taking HRT around the time of menopause.